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General NPI Number Information
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NPI Number | 1770420218
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Entity Type | Individual
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Provider Name | KAYLEY CRANDALL
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Gender |
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Dates
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Enumeration Date | 05/01/2026
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Last Update Date | 05/01/2026
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Provider Practice Location Address
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Address Line | 6501 GRAPE RD STE 1205A
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City | MISHAWAKA
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State | IN
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Zip | 46545-1007
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Country | US
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Telephone | 574-347-5789
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Fax |
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Provider Business Mailing Address
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Address Line | 26191 E SHORE DR APT 2
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City | EDWARDSBURG
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State | MI
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Zip | 49112-8488
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Country | US
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Telephone | 574-347-5789
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZA2600X
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Taxonomy Name | Medical Art Specialist/Technologist
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License Number |
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License Number State | IN
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